An audit examining the post-fall management of inpatient falls resulting in neck of femur (NOF) fractures

Title: An audit examining the post-fall management of inpatient falls resulting in neck of femur (NOF) fractures. 

Background:

Inpatient hip fractures are a significant cause of morbidity and mortality in older patients.  National audits have identified multiple delays in the care of these patients.

Aims

To analyse the pathway of patients sustaining an inpatient hip fracture at our trust 

Method:

We examined medical records of patients sustaining inpatient hip fractures from 2020-2021 to collect data on; transfer method from floor, time to medical and geriatrician review, documentation of suspicion of hip fracture, analgesia given, times from fall to X-ray and surgery. We used standards from the National Hip Fracture database, the National Audit of Inpatient Falls and Royal College of Emergency Medicine guidelines. 

Results: 

15 patients were included. None were transferred using flat-lifting equipment.

33% received a medical review within 30 minutes, in 47%, a hip fracture was not suspected. 53% were given a fascia-iliaca block, 33% were managed with paracetamol. 

Average time from fall to x-ray request was 14 hours, from request to completion 6.27 hours, and from fall to x-ray 20.23 hours. 73% had surgery within 36 hours.

Discussion:

This audit highlights significant delays in the diagnosis of hip fracture and sub-optimal analgesia. There is scope for a standardised post-fall management algorithm for doctors to optimise the care of older patients with an inpatient fall sustaining injury.  

References:

1. NAIF annual report 2022 Royal College of Physicians